Sometime as nurses we are faced with difficult situations that challenge us personally, morally, and cognitively. One opportunity that was presented to us during our community rotation was to partake in the Tuberculosis Directly Observed Therapy, also known as the DOTS program. TB is a common disease here in the Philippines, in Canada we also have a higher prevalence in certain areas. It is something that Canada no longer vaccinates for; however the incidence and prevalence of the disease are increasing. The plan for us was to be observing the counseling and the medication administration of the TB drugs to new active TB cases.
We were informed that we would be provided with a simple mask for our protection. As we have learned, TB is transmitted via the aerosol route. At home in Canada we use N95 respirators and reverse isolation rooms that are used to prevent the transmission of TB. N95 respirators are masks that are more finely woven compared to a simple mask, ensuring that the bacterium cannot permeate the mask. We were told that in order to lessen the chance of transmission we could use techniques such as turning of our bodies, standing at the back of the room, using the simple mask, and that the positive cases will not be talking. We didn’t feel that the simple mask would be effective enough for our protection. We do realize we have more than likely been exposed to TB already, having worked in the community but felt that more cases in one location meant a greater chance of being infected. We took the information presented to us and discussed it amongst our group using our emic perspective and felt that the risks outweighed the benefits of us attending the program. We were really conflicted as we did want to offend anyone by not attending the program but we also did not want to put ourselves into a position where we felt uncomfortable. In the end we decided not to attend the program.
After making this difficult decision, we discussed with Susan Fowler-Kerry, our faculty resource advisor and mentor, she enlightened us with her view of the situation. We knew when we signed up for this trip that we would be exposed to infectious diseases and that we would experience personal difficulties however we did not know to what extent. There was no way that she or anyone for that matter could prepare us for what we would be experiencing. What we have learned from this situation is that TB is but one of many communicable diseases that we will be exposed to. TB is less contagious than other diseases such as influenza or chicken pox. A person needs more than one exposure to be infected, exposure may not always mean you will get TB. We do not exhibit risks factors which include being immunocomprised, living in cramped conditions, being Aboriginal, and being homeless, or incarcerated. Rates are higher among children and that is who we were working with in Janiuay.
What we have learned from this is that we should have looked outside of our emic view, researched and informed ourselves in greater depth. Had we known, we would have felt more comfortable bringing our own N95 masks in order to protect ourselves and not miss out on an opportunity.
This experience has given us the opportunity to use our critical thinking abilities and make decisions on our own. This will help us in our practice as we are working towards becoming autonomous nurses. We will continue to question our own thoughts, actions, and feelings in order to better our practice; to live each day with the goal of being a lifelong learner.